January 31, 2010

In You Can't Take it With You Lionel Barrymore's character makes the above comment about another character's facial movements.

Here's a video of the scene, although there are better examples of the abnormal movements in the scene directly before this one.

Whether John Blakely's (Clarence Wilson) facial twitching is acted or hemifacial spasm is not clear. It certainly looks like hemifacial spasm with unilateral clonic jerks involving the eye and mouth. The eyebrow here appears uninvolved although usually it elevates. Most cases are caused by vascular compression of CN VII and a much smaller number of secondary cases follow recovery after Bell's Palsy. Even fewer cases are caused by brainstem lesions. The treatment of choice is botulinum toxin, not available in 1938. As for attributing the symptoms to stress, other than possible worsening in the setting of stress, there's no evidence that rest will cure the symptoms.

Since hemifacial spasm may in a minority of cases represent something sinister, I agree with Mr. Barrymore: "Look out for that twitch, Mr. Blakeley."

January 24, 2010

January 20, 2010

In the glazed red brick building at 1 Hoxton Square in London, James Parkinson lived and worked. He inherited the first floor office when his father died. The blue plaque is obscured by the restaurant umbrella. St. Leonard's, Shoreditch, the church where he was baptized, married, buried, is just down the road. Its portico is now a homeless shelter.

In the paved yard around St Clement Danes Church on the Strand in London stands this statue of Samuel Johnson. His hair, reminiscent of the frontal lobes of a dolphin brain, makes him recognizable from behind.His list of achievements speak volumes about the man, and according to his last descriptor, he could speak volumes.In the tradition of posthumously diagnosing past luminaries with current medical diagnoses, his list of descriptors could include Touretter. Movement disorders by their very nature are visible. Johnson's contemporaries chronicled his tics, motor and verbal. They also described obsessive compulsive behaviors. Johnson's remarkable intellectual output may have been the natural counterpart to his observed insuppressible motor energy.

The documentary evidence for Johnson's tics and obsessive compulsive behaviors is documented in this article from The Journal of the Royal Society of London.

January 7, 2010

Tom Haywood, a senator from Texas, died in 2001 from progressive supranuclear palsy. Photographed with his family, it is easy to identify that who has PSP. The facial expression of PSP is homologous to the extreme neck rigidity: there is facial akinesia with varying degrees of tonic contraction of the facial muscles. This sometimes includes a perpetually furrowed brow. Drawing from Goetz, C.G. (1987) Charcot, The Clinician. New York: Raven Press. Private Collection of MDS Member, Christopher G. Goetz, MD, Chicago, IL. Taken from MDS website.

The appearance makes it difficult to gauge a patient's comfort and mood. It can also lead caretakers and medical staff to overestimate the degree of cognitive impairment. There is currently no effective treatment for PSP, neither symptomatic relief of the rigidity and gait difficulty nor medication to slow its progression. However, there are ongoing clinical trials, so identification of the disease (which can be confused with Parkinson's Disease) is important for recruiting patients for these studies.